1
|
Gasca-Lozano LE, Lucano-Landeros S, Ruiz-Mercado H, Salazar-Montes A, Sandoval-Rodríguez A, Garcia-Bañuelos J, Santos-Garcia A, Davila-Rodriguez JR, Navarro-Partida J, Bojórquez-Sepúlveda H, Castañeda-Gomez J, Domínguez-Rosales J, Ruiz-Arcos MA, Sánchez-Parada MG, Armendariz-Borunda J. Pirfenidone Accelerates Wound Healing in Chronic Diabetic Foot Ulcers: A Randomized, Double-Blind Controlled Trial. J Diabetes Res 2017; 2017:3159798. [PMID: 29675430 PMCID: PMC5840678 DOI: 10.1155/2017/3159798] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 11/16/2017] [Accepted: 12/03/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetic foot ulcers are one disabling complication of diabetes mellitus. Pirfenidone (PFD) is a potent modulator of extracellular matrix. Modified diallyl disulfide oxide (M-DDO) is an antimicrobial and antiseptic agent. AIM To evaluate efficacy of topical PFD + M-DDO in a randomized, double-blind trial versus ketanserin in the treatment of noninfected chronic DFU. METHODS Patients received PFD + M-DDO or ketanserin for 6 months. Relative ulcer volume (RUV) was measured every month; biopsies were taken at baseline and months 1 and 2 for histopathology and gene expression analysis for COL-1α, COL-4, KGF, VEGF, ACTA2 (α-SMA), elastin, fibronectin, TGF-β1, TGF-β3, HIF-1α, and HIF-1β. RESULTS Reduction of median RUV in the PFD + M-DDO group was 62%, 89.8%, and 99.7% at months 1-3 and 100% from months 4 to 6. Ketanserin reduced RUV in 38.4%, 56%, 60.8%, 94%, 94.8%, and 100% from the first to the sixth month, respectively. Healing score improved 4.5 points with PFD + M-DDO and 1.5 points with ketanserin compared to basal value. Histology analysis revealed few inflammatory cells and organized/ordered collagen fiber bundles in PFD + M-DDO. Expression of most genes was increased with PFD + M-DDO; 43.8% of ulcers were resolved using PFD + M-DDO and 23.5% with ketanserin. CONCLUSION PFD + M-DDO was more effective than ketanserin in RUV reduction.
Collapse
Affiliation(s)
- Luz E. Gasca-Lozano
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Silvia Lucano-Landeros
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Héctor Ruiz-Mercado
- Regional Hospital Dr. Valentín Gómez Farías ISSSTE, Guadalajara, JAL, Mexico
| | - Adriana Salazar-Montes
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Ana Sandoval-Rodríguez
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Jesus Garcia-Bañuelos
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | | | | | | | | | | | - José Domínguez-Rosales
- Institute of Chronic-Degenerative Diseases, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | - Myriam A. Ruiz-Arcos
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
| | | | - Juan Armendariz-Borunda
- Institute for Molecular Biology and Gene Therapy, CUCS, University of Guadalajara, Guadalajara, JAL, Mexico
- Tecnologico de Monterrey, Campus Guadalajara, Jalisco, Mexico
| |
Collapse
|